Green Supply Chain Management in Hospitals

Subject: Management
Pages: 9
Words: 8187
Reading time:
31 min
Study level: PhD


In recent decades, the level of environmental awareness among the public has increased significantly in relation to different sectors, including the healthcare industry. The health care expansion effect has led to increased hospital operations and increased sensitivity to Hospital relatedness to sustainable management, among other environmental-related concerns. These changes, among other issues, have triggered a globalized effort that has led to the establishment of global standards to address concerns that link to global environmental management issues in different nations (Standards: ISO standards are internationally agreed by experts 2020). Various hospitals in Australia and other countries have tasked their agencies that relate to public health, such as the Australian Department of Public, to ensure enrolments of the international standards such as ISO 22870, ISO 151197, and ISO 9001 in different health care industry operations. The application of the ISO standards ensures effectual quality service delivery satisfies all stakeholders’ preferences (International standards 2020). The application of the international standards, however, follows different actions to ensure success in the health care industry

In line with increased environmental awareness, administrators are tasked with significant roles that involve making critical decisions that alter different hospitals’ operations. In line with other environmental demands, the administrators have also employed critical approaches to supply management while refocusing on creating green supply chains to reduce energy and resource consumption, address the lack of recycling, and improve waste management (Camgöz-Akdağ et al. 2016). The change necessary to address the problem involves altering hospital functional processes to rhyme with the systematic approach applied globally to improve Hospital management and create other options that will result in sustainable management. The changes aim at critical issues started in international standards operations that involve Customer satisfaction and continuous provision of high-quality products regardless of organizations’ scope of practice (ISO 9001:2015 2019). The significant changes are equally linked to environmental factors, which enhance environmental performance and achieve environmental sustainability objectives (ISO 14001:2015 (en) Environmental management systems — requirements with guidance for use 2020).In this context, hospitals are identified to face the challenge of increased expenses for using medical and non-medical supplies, and they are seeking ways to reduce both costs and the negative impact on the environment.

Despite the focus of modern organisations on applying the principles of green supply chain management, the healthcare sector across the globe can be viewed as being at the initial stages of transitioning to green supply chain management. The reason is that hospital management has only recently begun to develop strategies that correspond with the requirements of ISO 14001-2015 and ISO 9001-2015 (Gerwig 2015). The key requirements of ISO 14001-2015 and ISO 9001-2015 involve developing hospital performance practices that incorporates the needs of stakeholder plus incorporating the needs of the changing environmental demands that do not alter the efficient operations of any organization (ISO 14001:2015 2020; Noviantoro et al. 2020). The recent implementation of the ISO standards has led to improved Hospital operations including increased focus on patient operation promoted by employment of internal processes improvement decisions that promotes increase efficiency levels in hospitals operations. As Noviantoro et al. (2020) state, the integration of the ISO standards in green supply chain policies in different hospitals has involved this process of developing new operational principles that cater for the enhancing the environment sustenance level and in consequence improving the operational efficiency levels in different organizations.

In order to address the said situation, some hospitals in such countries as Australia and Turkey chose the principle of green supply chain management. Thus, managers from the healthcare industry have implemented green supply chains according to International based standards. The managers aim to increase environmental performance levels and improved hospital abilities to meet customer needs in providing its services (ISO 9001:2015 2019; ISO 14001:2015 (en) Environmental management systems — requirements with guidance for use 2020). These changes ensure guaranteed environmental friendly management approaches (Stoimenova, Stoilova & Petrova 2014; Toprak & Şahin 2013). In this context, it is important to research what challenges were faced at the stage of implementing green supply chains in hospitals in both countries and what benefits were achieved. This chapter presents the background for the study, the rationale for this research, aims of the study, research questions, the contribution to theory and practice, the statement of significance, and a conceptual framework.

Research Background

The application of effective management practices in hospitals plays a key role in contributing to the healthcare industry’s better performance. Studies indicated that the adoption of the most efficient and evidence-based management practices in hospitals guarantees reductions in patient mortality rates, improvements in patient outcomes, enhancements in providing care, and positive changes in operations and workforce’s activities (Dobrzykowski et al. 2014; Machado, Scavarda & Vaccaro 2014). In this context, effective management practices include techniques associated with organising the work of staff, delivering care, distributing funds, using equipment, and promoting retention, among others (Chiarini 2015). This section presents the discussion of healthcare management practices adopted in hospitals of Australia and Turkey, focusing on the review of supply chain management principles followed in the healthcare sector to provide the background for the current research

Healthcare Management Practices in Hospitals in Australia

The healthcare system of Australia includes both public and private sectors. The annual healthcare expenditure for this industry in the country is about $AU100-110bn (The Royal Australian College of General Practitioners 2015). The public sector represents about 70% of the industry in terms of provided funding covered by the federal government (40% of funding) and state governments (60% of funding). Thus, about 30% of the industry are privately funded (Bhakoo, Singh & Sohal 2012). Public hospitals remain most popular among Australians because of the high quality of provided care, and about 60% of patient admissions are addressed to public hospitals in Australia (The Royal Australian College of General Practitioners 2015). In spite of an appropriate budget adopted for hospitals in Australia, the quality of the work of a healthcare system depends on effective management. The problem is that healthcare costs increase each year and certain changes to demography have led to developing challenges for managing healthcare facilities successfully and providing high-quality services to implement working management practices.

From this perspective, managers in Australia Hospitals work to adopt specific practices to improve, maintain, and effectively monitor healthcare operations, workers’ performance, people management, care delivery, quality management, waste management, and the work of a supply chain. In Australian hospitals, much attention is paid to guaranteeing the high quality of provided services and ensuring that the length of patient stay is appropriate, and spent costs are reasonable (Agarwal et al. 2016). In order to achieve these results, managers improve used protocols, promote the utilisation of the most efficient clinical practice guidelines, focus on the most effective organisational practices, and change hospital layouts to address patient flows (The Royal Australian College of General Practitioners 2015). In addition, they introduce advanced technologies to provide care for more patients and exchange knowledge and data, implement practices to reduce expenses, and focus on innovative and cost- and resource-efficient management approaches (Agarwal et al. 2016; Bhakoo, Singh & Sohal 2012).

In order to build accountability in Australian hospitals, managers and administrators focus on implementing new systems for working with material and human resources, evaluating performance and outcomes, ensuring sustainability, and guaranteeing high-quality care. For this purpose, healthcare administrators change their approaches to addressing a community’s needs and patients’ expectations, managing waste, developing supply chains, and monitoring performance (Bhakoo, Singh & Sohal 2012; Rodwell & Gulyas 2013). As a result, levels of employee commitment and the quality of care in Australian hospitals are comparably high according to recent statistics for the industry (The Royal Australian College of General Practitioners 2015). Therefore, it is possible to state that modern healthcare management practices adopted in public and private hospitals of Australia are oriented not only to the improvement of patients’ treatment but also to the use of most cost-efficient approaches in their practice.

However, not all Australia Hospitals are managed effectively to address patients’ needs, stakeholders’ interests, and save costs. The adoption and work of management practices in the healthcare industry depend on various factors, including managers’ leadership, the type of implemented practices, management areas covered during change processes, the staff’s response, and specifics of cooperation with suppliers From this perspective, administrators in the most successful Australia Hospitals tend to pay much attention to managing their operations and applying supply chain management principles (Agarwal et al. 2016; Böhme et al. 2014). The choice of the most effective approaches in this case is based on hospital-specific features that determine paths selected by managers in the healthcare industry to achieve higher outcomes for patients and decrease associated costs.

Large Australian hospitals with more beds and patient flows usually demonstrate more strict management, effective performance, and high-quality care because of the adoption of the most efficient managerial practices appropriate for the healthcare industry. Nevertheless, these hospitals, which often belong to the public sector, also face the most critical challenges and barriers to decreasing costs, balancing expenses, and avoiding the negative impact on the environment and community because of their activities (Böhme et al. 2014; The Royal Australian College of General Practitioners 2015). Moreover, supply chains in the healthcare industry in Australia differ significantly from other sectors. All these aspects influence Australia hospitals’ necessity to revise their policy with the focus on strategies, methods, and supply chain management improvements in these facilities and contribute to sustainability and corporate responsibility.

Healthcare Management Practices in Hospitals in Turkey

In Turkey, the healthcare industry is accounted for about 6% of the country’s GDP, and it is represented by public and private sectors (Polater, Bektas & Demirdogen 2014). However, in spite of paying much attention to funding this industry, there are still management issues that can be observed in different types of Turkish hospitals. The healthcare industry is constantly growing and developing in order to address national health goals, and as a result, it is oriented to adopting changes and using a variety of efficient healthcare management practices. Technological improvements and enhancements in the quality of provided services are typical of the Turkish healthcare sector (Akdaǧ 2015; Erus & Hatipoglu 2013). Although much attention is paid to innovation and changes, common issues include the reference to ineffective managerial practices and processes, the inappropriate utilisation of resources, the use of outdated systems for sharing information, the use of ineffective cost distribution and control strategies, as well as the application of inefficient waste management (Akdaǧ 2015; Erus & Hatipoglu 2013; Polater, Bektas & Demirdogen 2014).

From this perspective, it is possible to state that healthcare management practices applied in Turkey’s Hospitals are most effective when they are oriented to change management. With that said, this direction does not resolve the matter entirely, and other measures will also need to be applied to maximise performance. According to Özkan, Akyürek, and Toygar (2016), there are problems with managing healthcare personnel, organising effective healthcare logistics, and controlling the work of supply chains to reduce costs and address the inefficient use of resources. Camgöz-Akdağ et al. (2016) also agree that healthcare management practices in Turkey require improvement. The focus should be on integrating strategies and techniques that can help healthcare providers and administrators reduce costs and funding and change the approach to using resources, and achieve better outcomes for patients. This aims carter the demands of interntional standards provisions that requires enhancing organizational operations to carter for management inefficiencies that alters the ability of the hospital to meet higher level of customer satisfaction through effective application of the system including making process improvement to conform to statutory and regulatory requirements Thus, administrators in Turkey’s Hospitals have achieved significant positive results in implementing innovation and change in their organisations. However, the basic healthcare management practices still need to be improved and developed.

The healthcare sector’s focus on innovation and change is the adoption of national policies directed towards the promotion of the universal health coverage for all citizens in Turkey among other initiatives (Akdaǧ 2015; Erus & Hatipoglu 2013). From 2002 through 2012, Turkey’s healthcare industry experienced significant changes in the context of realising the principles of the national Health Transformation Program. On its path to providing universal health coverage, Turkey achieved the improvement of the nation’s health status, decreases in infant mortality rates, and increases in patient satisfaction. The overall access to healthcare increased for different categories of the country’s population, and this aspect created more challenges for organising the work of healthcare personnel in hospitals (Akdaǧ 2015; Erus & Hatipoglu 2013). Despite the fact that updating health information systems, reorganising resources in healthcare facilities, redistributing costs, and improving supply chains were tasks required for completing in the context of the Health Transformation Program, there are still barriers to achieving these goals.

Moreover, it is important to note that changes in the country’s healthcare industry have led to attracting more healthcare practitioners to public hospitals because of increased incentives. As a result, approaches to organising specialists’ work and using resources have been changed as supply chain management principles were followed inappropriately in many cases (Akdaǧ 2015; Erus & Hatipoglu 2013; Özkan, Akyürek & Toygar 2016). Thus, inefficiency in the work of public hospitals of Turkey can be observed even today in spite of efforts made by healthcare administrators to address the problem. From this perspective, it is possible to state that healthcare management practices used in Turkish hospitals are developed to address the policies associated with Health Transformation Program that have been realising in the country during a decade. However, there are still problems with integrating practices that can reduce costs and improve the use of resources without compromising the quality of care.

Supply Chain Management in Healthcare in Australia and Turkey

In 1982, the concept of supply chain management was used to only explain to organizations the specifics of logistic management concerning different types of organisations and providers of resources and services (Asgari et al. 2016). Later, supply chain management was “integrated with the sustainable development concept to create many new trends in the academic field,” and the idea of “sustainable supply chain management was proposed by Linton in 2007” (Liu et al. 2017, p. 422). While the realisation of SCM principles in the healthcare industry is a challenging task, managers are focused on reaching the goal of developing effective hospital supply chains.

These processes are associated with mitigating increases in expenses, improving resource usage, and patient care quality improvement. Nevertheless, the process of moving to the efficient supply chain management is complex, and currently, only a few healthcare industries worldwide can be characterised by having strategically efficient and collaborative supply chains including hospitals (Maleki & Cruz-Machado 2013; Rakovska & Stratieva 2018). The problem is that supply chains involving hospitals can be viewed as fragmented because of participants’ independent activities in these chains (Gerwig 2015; Polater, Bektas & Demirdogen 2014). In the healthcare sphere of Australia and Turkey, supply chain management is related to developing efficient structures and systems of governing hospitals and other facilities, developing productive relationships with suppliers, improving procurement and resource management, and implementing IT systems (Agarwal et al. 2016; Camgöz-Akdağ et al. 2016).

Supply chains are based on a series of interdependent transactions between all participants of the chain, and much attention should be paid to their collaboration. The major participants of healthcare supply chains in Australia and Turkey include different types of manufacturers, such as providers of equipment, specific hospital supply, and pharmaceutical companies, distributors, individual providers of specialised medical services, insurance companies, national and state agencies, governmental authorities, employers, and patients (Agarwal et al. 2016; Bhakoo, Singh & Sohal 2012; Böhme et al. 2014; Camgöz-Akdağ et al. 2016). The success of the work in a hospital depends on the cooperation of all these actors because they need to guarantee the on-time delivery of high-quality services for the population. Currently, the authorities in both Australian and Turkish hospitals are oriented to implementing more efficient SCM practices to make hospitals effectively operating systems. However, they have to contend with the novelty of supply chain management’s application in the healthcare industry, and many modern hospitals have no experience in integrating the required changes effectively and achieve the goal of optimising supply chains along with thew associated improvements.

The key SCM-related tasks faced by healthcare administrators in hospitals of Australia and Turkey include improving the management of inventory, facilitating public-private collaboration, and predicting the patient mix to guarantee the efficient use of available resources (Agarwal et al. 2016; Özkan, Akyürek & Toygar 2016). At this stage, administrators and managers of hospitals in Australia and Turkey consider opportunities for developing supply chains in the most efficient manner, and the universal response to this issue is the implementation of green supply chain management principles (Camgöz-Akdağ et al. 2016; Chege 2012). Green supply chains address the idea of sustainability not only in terms of the effective utilisation of resources and inventory management but also in terms of minimising waste and an overall negative impact of hospitals’ operations on the environment.

As was mentioned before, SCM application in hospitals is a comparably modern trend, and scholarly literature and practice within the last twenty years have been divided on the topic of green supply chains. Thus, the focus in hospitals and other healthcare facilities in Australia and Turkey seems to be moved from guaranteeing the high-quality care while using minimum resources to providing high-quality care while minimising the complexity of all processes and their negative effects on the environment (Agarwal et al. 2016; Bhakoo, Singh & Sohal 2012; Camgöz-Akdağ et al. 2016). When choosing the path of modernising supply chain management and even selecting strategies connected with green supply chains, hospitals all over the globe begin to save their human and material resources, address a community’s needs more efficiently, protect the environment, and reduce expenses (Agarwal et al. 2016; Maleki& Cruz-Machado 2013). Therefore, one of the major strategic goals usually considered by administrators or managers in hospitals is the realisation of effective supply chain management.

One more characteristic of a hospital supply chain in Australia is its dependence on the aspects of total quality management. There are many international, national, and regional standards and guidelines that determine the quality of provided services in hospitals, thus affecting the work of a supply chain (The Royal Australian College of General Practitioners 2015). Furthermore, the variety of these standards is high because specific norms and rules are followed in different regions of Australia, and the healthcare industry of the country is not interconnected, and cooperation within supply chains in different regions is based on various guidelines.

It is also important to note that a hospital supply chain based on three key actors can be expanded to include government agencies and insurance companies. The necessity of collaborating with these actors also influences the development of supply chains in Australia through affecting direct and indirect paths of spreading resources (Bhakoo, Singh & Sohal 2012; Böhme et al. 2014). As it was noted earlier, the indirect path involving wholesalers and distributors is more typical of the Australian hospital supply chain (Rakovska & Stratieva 2018). In spite of the fact that hospitals in many countries often choose the direct cooperation, researchers noted that the intermediation involving wholesalers and distributors can have positive economic outcomes for hospitals (Bhakoo, Singh & Sohal 2012; Rakovska & Stratieva 2018). From this perspective, it is possible to state that the level of interrelatedness between actors of hospital supply chains in Australia is high, but the overall level of similarity between public and private hospital chains or between supply chains in different regions of the country is comparably low.

Although the authorities in hospitals in Turkey have focused on implementing supply chains, especially green supply chains, into their healthcare systems, there is still the lack of data regarding this process. Some researchers agree that the shift to green supply chains observed in the industry is a stable phenomenon that will lead to positive changes in the sphere in the future (Akdaǧ 2015; Özkan, Akyürek & Toygar 2016). Other researchers point at a range of barriers and challenges associated with the process, and they note that overcoming these issues can take years for hospitals in order to understand what type of a supply chain can work best in this or that context (Camgöz-Akdağ et al. 2016; Erus & Hatipoglu 2013; Polater, Bektas & Demirdogen 2014). As a result, more research is required in order to understand what particular tendencies are followed in hospitals in Turkey in terms of developing the effective supply chain management based on creating green supply chains.

Rationale for Research

The practical application of green SCM approaches in the healthcare industry is still almost unstudied in contemporary literature despite the current interest of researchers in investigating this problem in different sectors, including healthcare. In spite of the fact that many hospitals in different countries choose to transform their supply chain management into green supply chain management to reduce waste, focus on recycling, and eliminate a negative impact on the environment, additional research is still required in this field (Chakraborty & Dobrzykowski 2014; Kovac 2014). Moreover, scholars and practitioners have to pay attention to the fact that those practices that are used by managers to make their supply chains green require further investigation in a specific healthcare industry. Furthermore, the national factor is also important in this context because green supply chain strategies and practices selected by healthcare managers in various countries differ significantly.

As a result, it is assumed that the experience of hospitals in Australia and Turkey on their paths to building green supply chains is different, with the focus on certain barriers, challenges, advantages, and disadvantages associated with this process. The problem is that more research is required to examine how hospitals can successfully apply green SCM practices to address the idea of sustainability and reduce their environmental influence with reference to specific case studies. Moreover, research is also required in order to understand how the application of ISO 14001 and ISO 9001 can influence the process and lead to developing green supply chain management in this or that facility (Muzaimi, Chew & Hamid 2017). The ISO application provisions demands for innovative process change on the current organizational operations that carter for the current customer needs and other current environmental demands (Ferreira, Poltronieri & Gerolamo 2019). Although discussing supply chains in the healthcare industry researchers often refer to ISO 14001 and ISO 9001 standards, there is still no appropriate evidence to state that the application of these standards is directly associated in hospitals with their realisation of green supply chain management.

Certain practices are important to be implemented in Australian and Turkish hospitals to improve supply chain management to overcome challenges associated with high costs, disintegrated processes, and resource-consuming operations. As a result, the rationale for conducting this study is that there is the lack of literature on comparing the experience of hospitals from different contexts regarding the development of green supply chains. Moreover, there is also the lack of literature on discussing the application of ISO 14001 and ISO 9001 in this area. Finally, more recommendations for practitioners are required to be formulated as a result of this study. It is important to investigate how the application of ISO 14001-2015 and ISO 9001-2015 standards can contribute to building strong integrated green supply chains based on dyadic relationships in Australian and Turkish hospitals. It is also critical to compare the findings for two national contexts using a mixed-methods case study design.

Aims of the Study

First, this research aims to evaluate and describe the specific connection between the application of green SCM principles and successful compliance with the ISO 14001-2015 and ISO 9001-2015 in certain selected hospitals in Australia and Turkey. Further research should examine how hospitals in Australia and Turkey can apply green SCM and ISO 14001 and ISO 9001 and integrate them into its daily practices because the trend of greening practices is comparably new for the healthcare industry all over the globe (Bhakoo, Singh & Sohal 2012;Camgöz­-Akdag et al. 2016). The second aim for this research is to determine and explain the procedures that are necessary for applying effective greening strategies that comply with ISO 14001-2015 and ISO 9001-2015 in the healthcare industry of both countries. Finally, the third aim is to compare and contrast processes of greening supply chains with reference to ISO 14001-2015 and ISO 9001-2015 in the selected hospitals of Australia and Turkey to conclude which approach is more environmentally friendly.

These aims reflect the need for examining green supply chain management strategies in the selected hospitals to provide the background for additional research on the topic, determining how these case studies are representative of greening practices in some hospitals of Australia and Turkey. The research does not aim at comparing the hospitals’ achievements in greening supply chains based on the type of ownership, and the focus is on comparing practices in different national contexts. The aims address critical issues determined for Australian public and Turkish private hospitals, which have grappled with the problem of increased healthcare expenditures and the negative impact of management on the natural environment due to the growing number of patients, along with the increased volume of waste.

Moreover, these processes may be connected with increasing activities in hospitals over the past decades (World Health Organization 2014). The problem is that, in Australia and Turkey, public and private hospitals only start focusing on green supply chain initiatives, and the overall process of shifting standard managerial processes to this specific greening practice is rather complex and problematic (Bhakoo, Singh & Sohal 2012; Camgöz-Akdağ et al. 2016). The complexity of health care sector operations continues to intensify in the current period. And as noted in the ISO provisions, Hospitals are to ensure that current issues are addressed considerably and more innovative approaches are used to ensure successful implementation of environmental management processes (Noviantoro et al. 2020; Sepetis 2019). Such innovative measure includes the management policies applied by different organization in the implementation of green supply management.

Consequently, at this stage, supply chains in Australian and Turkish hospitals can be viewed as mostly disintegrated. The reason is in faced problems with information sharing, controlling processes, and planning interactions with suppliers and customers. Social costs that are associated with these challenges are high because they affect the quality of proposed services and care (Chakraborty, Bhattacharya & Dobrzykowski 2014). In order to address these problematic questions, the current research will be built on a new framework that is based on the explanation of the influence of innovative greening practices on the traditional organisation of business and logistics management processes in the healthcare industry.

Research Questions

This study examines specific cases related to adopting SCM practices in hospitals of Australia and Turkey and their success in following ISO 14001-2015 and ISO 9001-2015 standards. In order to address the purposes and aims of the study, it is necessary to respond to the following main research question:

Research Question: What are the main benefits and challenges of implementing integrated green supply chain management in Australian hospitals in comparison to Turkish hospitals?


  1. What is the significance of greening hospital supply chains in Australian and Turkish hospitals?
  2. How can SCM changes in hospitals, both public and privately owned, of Australia and Turkey be promoted effectively?
  3. Why is the application of ISO 14001-2015 and ISO 9001-2015 in the context of integrated green supply chain management appropriate for Australian and Turkish hospitals?
  4. What integrated green supply chain management procedures, corresponding with ISO 14001-2015 and ISO 9001-2015, are applicable to healthcare sectors in Australia and Turkey?

ISO 9001 and ISO 14001

The ISO 9001 and ISO 14001 standards are used by the International Organization for Standardization. The former is the better-known of the two, as it covers the foundations of a quality management system. Most businesses have recognized the utility of such a framework, and it has become standard to create one. The ISO offers certification that confirms an organization’s compliance with the ISO 9001 standard, which has helped establish its reputation. ISO 14001 is a similar standard to ISO 9001 that sets out the basic standards for creating an environmental management system. It can also be certified to, but, since it is a newer development, as indicated by the higher family number, it is not as popular as its quality-related counterpart. With that said, certification in either standard can provide the assurance that the organization’s systems are based on a sound design approach to its employees and stakeholders. Moreover, the basic structure can serve as a foundation for the development of a more advanced green framework that takes the context of the organization into consideration.

Contribution to Knowledge

This study significantly contributes to both theory and practice related to the topic of implementing green supply chains in the healthcare industry. The reason is that the lack of research is currently observed regarding this issue, and there are many aspects to examine and discuss while referring to the contexts of Australian and Turkish hospitals. Specific theoretical contribution and practical contribution will be considered and discussed below.

Theoretical Contribution

The development of modern healthcare sectors in both Australia and Turkey is rapid due to significant increases in numbers of patients requiring treatment and new functioning hospitals. However, the problem is that such increase in the volume of the healthcare sector operations directly affects the condition of the natural environment in Australia and Turkey (Agarwal et al. 2016; Akdaǧ 2015). Therefore, a specific impact of healthcare operations on the natural environment has become a subject of scientific and management interest that requires its further discussion and analysis. The issue is specifically related to the situation with Australian hospitals because the national government emphasises the implementation of advanced greening techniques to minimise the negative impact of the healthcare industry on the natural environment (Bhakoo, Singh & Sohal 2012; Böhme et al. 2014).

The similar situation is observed in Turkey, where the government published a series of regulations in order to improve waste management processes in different sectors, including the healthcare sector (Camgöz-Akdağ et al. 2016). To address the negative impact of the absence of recycling procedures and effective waste management techniques, companies and international organisations develop environmentally friendly approaches to management, such as green supply chain management, that is the transition from traditional supply chains to eco-friendly ones (Özkan, Akyürek & Toygar 2016). As a result, it is essential to understand the role of integrated green SCM in greening healthcare business procedures, along with possible benefits, when considering public and private medical facilities in Australia and Turkey.

From this perspective, this research will add to the scholarly SCM literature in healthcare and green supply chain management in Australian and Turkish public and privately owned hospitals. It is possible to state that, currently, the identified subject of interest lacks the detailed investigation, discussion, and analysis, especially in terms of comparing adopted green SCM practices in the hospitals of Australia and Turkey. Therefore, the proposed research seems to have theoretical significance as the planned study will also discuss the application of ISO 14001-2015 and ISO 9001- 2015 in the context of the healthcare industry as the framework for developing green supply chains (Agarwal et al. 2016; Camgöz-Akdağ et al. 2016; Özkan, Akyürek & Toygar 2016). The analysis of potential drawbacks and benefits connected with arranging integrated green SCM based on the requirements set by these two standards in Australian and Turkish hospitals will also add to the theoretical significance of the study.

Practical Contribution

There are many studies on specifics of applying ISO 14001-2015 and ISO 9001-2015 in healthcare organisations of different countries, but the limited research on the situation in Australia and Turkey is present. It is important to focus on how these standards can be used in hospitals over the globe. In the context of adopting the ISO 14001-2015 standard, it is expected that organisations will be able to reduce their waste, contamination of air, water, and soil, eliminate costs, and avoid the use of hazardous materials (International Organisation for Standardisation 2015). Furthermore, the application of the standard in hospitals is associated with decreasing the possibility of environmental accidents and enhancing performance because of decreased numbers of pollutants in the environment (Chege 2012). Therefore, while applying ISO 14001-2015, organisations become able to determine what environmental impact their operations have and how it can be addressed in terms of controlling activities, using resources, and manipulating inputs and outputs.

The problem of organising efficient green supply chains in Australian and Turkish hospitals to overcome the issue of polluting the environment and improving waste management is practical in its nature. The analysis of green supply chains in healthcare industries of these two countries allows for determining the most effective approaches to forming supply chains in order to achieve the highest outcomes for hospitals applying ISO 14001-2015 and ISO 9001-2015 standards, as well as for their communities which involve a move to meeting current community needs and other environmental management demands.(Muzaimi, Chew & Hamid 2017) From this point, the practical contribution of the study is that its results will help managers and administrators in public and private hospitals in Australia and Turkey to identify and overcome possible complexities or challenges that are related to using ISO 14001 and ISO 9001 standards as a foundation for their supply chain management procedures. The analysis of the hospitals selected depending on their application of the standards, the type of services provided and the approach to managing medical waste will allow for identifying green SCM practices associated with referring to ISO 14001-2015 and ISO 9001-2015 in different national contexts.

The findings will be helpful for administrators in hospitals to choose the optimal ways to apply ISO 14001-2015 and ISO 9001-2015 standards in their country. Moreover, it is critical to pay attention to the focus on the comparison of greening supply chains in Australia and Turkey that allows for determining factors that influence the quality and performance of adopted supply chain management practices. This approach will help managers from different countries to analyse what techniques are most applicable to their specific contexts following the historical changes and the current advanced demands (Bhakoo, Singh & Sohal 2012; Chakraborty, Bhattacharya & Dobrzykowski 2014; Zainudin et al. 2014). In addition, it is also necessary to consider the fact that the study findings will contribute to improving the healthcare sector of Australia and Turkey while determining the most efficient green SCM procedures with reference to policy evolution in this area.

Statement of Significance

This research has both theoretical and practical significance. The conducted study adds to the existing knowledge and theory on green SCM strategies and practices in different national contexts, especially in the healthcare industry with its specifics. Supply chain management in hospitals and, especially, green supply chain management are not well covered and discussed in the modern literature on management in hospitals in order to conclude what greening strategies and practices can be discussed as more or less effective in this or that context (Shen 2013; Silvestre 2016; Toke, Gupta & Dandekar 2010). As a result, more research is required in this field. In addition, the study potentially contributes to the generation of new knowledge following the pursuit of the more comprehensive investigation of green SCM strategies per the recommendations of ISO 14001-2015 and ISO 900-2015. Moreover, the study addresses new areas of research, such as the impact of greening and these standards on public and private sector hospitals in Australia and Turkey, along with the challenges connected with implementing such changes.

Furthermore, one of the factors that can maximise the study’s significance is the analysis of the increased impact of the healthcare sector on the natural environment, as well as a rising interest in seeking specific ways to diminish this influence. The reason is that the transition to environmentally friendly management strategies, as well as the focus on the legislation strictly controlling the level of impact on the natural environment, is a common tendency across most developed states (Mbaabu 2016; Min 2014). Still, the existing research in this area related to the contexts of such countries as Australia and Turkey does not cover this topic completely. The Australian and Turkish governments are currently taking their first steps in the direction of applying the principles of green supply chains in their hospitals, and numerous challenges and complexities are connected with the abovementioned transition due to a lack of appropriate theoretical and practical instruments and recommendations for making the process effective and productive (Böhme et al. 2014; Camgöz-Akdağ et al. 2016). Thus, additional research is required and expected in the field.

It is also important to state that the proposed research is of practical significance, and this aspect can be viewed and explained at several levels. Firstly, this study can be helpful and viewed as relevant for healthcare units in Australia and Turkey because they will receive within the framework required for implementing this challenging transition. Moreover, this study will illustrate the best methods of incorporating a theoretical investigation into the practical experience with the focus on green SCM approaches in hospitals of Australia and Turkey. As a result, recommendations provided in the study can consequently be applied by different healthcare organisations and units from similar contexts in order to avoid the most common problems in supply chain management, as well as maximise benefits. Moreover, the proposed research can be consulted and utilised by different companies across other industries to modify their practices in addition to learning how to adopt green supply chains.

Overall, it should be taken into consideration that administrators and managers can use the proposed findings to reduce environmental expenditures and the volume of resources utilised to make supply chains more effective. In addition, they will be able to focus on green management according to the principles and criteria associated with ISO 14001-2015 and ISO 9001-2015. From this perspective, the research demonstrates the significant potential value and connection to modern knowledge and practice.

Historical Background

Supply Chain Management

As it is stated in the literature on managerial processes and operations, supply chain management is a specific field of knowledge that is related to principles and norms of coordinating the work of supply chains to make them highly controlled and effective. There are a plethora of sources and research articles on the topic of developing supply chain management in different types of organisations because this area of knowledge has become actively applied to practice during recent years (Chakraborty & Dobrzykowski 2014; Maleki & Cruz-Machado 2013; Nassirnia & Robinson 2013). Therefore, it is important to review the existing literature on supply chain management in general and in the context of the healthcare industry in order to understand the specifics of covering these aspects in scholarly works.

Different types of firms choose to organise their supply chain management in order to improve the cooperation with suppliers and guarantee a high-quality end product for customers. The organization of supply chain management involves the firms’ application regulations that governs the supply chain process to realize the end measure of effective operations thus safeguarding any resulting consequence that may implicate the operating efficiency of the firms. In their study based on the review of the recent literature in the field, Chakraborty and Dobrzykowski (2014) found that collaboration within a supply chain is most required in healthcare organisations. However, according to the researchers, the problem is that it is rather difficult to achieve value co-creation in the context of supply chains because of many resources involved in the process. Thus, one can conclude that, in the context of healthcare organisations, supply chain management works to address the pressure of improving the quality of providing services and reducing costs.

Other researchers also discussed these aspects in their works. Referring to the experience of Brazil and supply chain management in its healthcare organisations, Machado, Scavarda, and Vaccaro (2014) stated that supply chains in this industry are usually external and internal, and organisations need to cope with coordinating both chains, and the role of effective supply chain management in this context is important. As a result, Chakraborty and Dobrzykowski (2014) and Machado, Scavarda, and Vaccaro (2014) agreed that supply chains in the healthcare industry are complex and involving combinations of different relations with participants and various products and processes at each stage of a chain. Therefore, supply chain management is critical to regulate these sophisticated systems to reduce costs and achieve higher outcomes.

Sustainable Supply Chains

In recent years, supply chains have become discussed in the context of the idea of sustainability. Today, researchers and practitioners are inclined to view supply chains through the prism of the effect of their activities on the environment because the rapid growth of businesses and operations in different spheres potentially leads to increasing the amount of waste and costs. In their study devoted to formulating an effective theoretical model for creating supply chains, Liu et al. (2017) proposed a certain framework for sustainable chains with reference to the idea that these networks or systems should be balanced in terms of the flows of resources, costs, and information within them. Moreover, their influence on the environment, including natural and social settings, should also be balanced and positive. The idea of sustainable development became popular in the 1980s, and it influenced the vision of modern supply chains significantly (Liu et al. 2017; Silvestre 2016). However, the concept of sustainable supply chain management was formulated in detail only in the 2000s.

Currently, it is possible to state that, when researchers speak about supply chain management, they mean a sustainable character of this management associated with the development of sustainable supply chains. According to the recent literature in the field, sustainability has involved innovation and creativity in management process that solves the current demands of the changing trends in the operation of different firms. In the few years back, the focus on sustainability was typical of researchers’ works in the 2000s and it shifted to managers’ and experts’ interest in green supply chains (Toke, Gupta & Dandekar 2010; Zainudin et al. 2014).

The current shift has only involved the options of the changing trends which demands for measure that manage effective use of resources and as well as safeguarding options of the current resources for future operational and economic benefits. Therefore, currently, sustainable supply chains are characterised by addressing the economic aspect of the business development, as well as the environmental one and the social one. As a result of this characterization, it is important to mention that this complex or holistic approach is preferred by managers in different types of organisations because of a range of expected positive benefits and advantages for firms in terms of addressing a community’s needs.

Integrated Supply Chains

The widespread development of integrated supply chains can be viewed as a modern tendency in supply chain management. While there were companies in the past that made efforts to control the entirety of their supply chains, they were considerably less numerous than they are now. Many organisations have become oriented to transforming their fragmented or separate supply chains into integrated ones in order to achieve a certain level of efficiency in operations and processes (Nassirnia & Robinson 2013). As a result, the concept of supply chain integration has recently developed further, and much attention should be paid to discussing specifics of integrated supply chains with reference to the existing literature on this issue.

The purpose of integrated supply chain management is to achieve control over most or all of its elements. In doing so, the company is able to modify its supply chain and refine to maximise efficiency (Maleki & Cruz-Machado 2013). In particular, one of the advantages of integrated supply chain management is better communication between its different elements, which now work toward a unified goal. This information sharing can also lead to the discovery and development of new synergies between different elements of the chain, reducing waste and improving efficiency. Additionally, the profit motive present in independent suppliers disappears, which can lead to lower costs for manufacturing and transporting supplies. While there are also challenges associated with adopting integration and adjusting systems across the supply chain to achieve the benefits, the advantages have popularised the concept.

Green Supply Chains

As it is stated in many studies on the topic, green supply chain management is oriented towards redesigning supply chain management into an effective system for the purpose of minimising a negative impact of organisations’ activities on the environment. Thus, as it is noted and explained in the review article by Toke, Gupta, and Dandekar (2010, p. 1), green supply chain management “refers to the way in which innovations in supply chain management and industrial purchasing may be considered in the context of the environment.” All the issues associated with implementing green supply chains are widely discussed in the scholarly literature today, and more attention should be paid to identifying tendencies in analysing these questions.

The conference Green Supply Chain 2018 that was conducted in Thessaloniki, Greece, on July 2-4, 2018, attracted researchers from all over the globe to discuss these particular issues. The key topics that were covered by experts included the following ones: supply chains and sustainability, the design of supply chains, collaboration within chains, performance measurement, practices of supply chain management, energy and water consumption, eco-design, and many others (Conference topics 2018). These topics are actively analysed and discussed by experts in order to reflect practitioners’ interest in these spheres. From this point of view, to address changes in managerial perspectives regarding supply chain management, it is important to focus on the recently published literature on the topic of green supply chains that have become actively explored by researchers.

ISO-14001-2015 and ISO-9001-2015

The ISO-14001-2015 is the latest revision of the family of standards created by the International Organization for Standardization (ISO). Per the International Organisation for Standardisation (2015), it specifies the requirements which an organisation has to satisfy to enhance its environmental performance comprehensively and without omitting critical details. It is designed to be applicable to any organization and scalable regardless of the size. Similarly, the ISO-9001-2015 standard is the current revision of the requirements for an adequate quality management system at an organization. International Organisation for Standardisation (no date) claims that it is the only constituent of the 9000 standard family to which a company can be certified, from which over 1 million organisations worldwide benefit. It is also applicable to any organisation, though it should be noted that this quality also means that it necessarily avoids specifics, favouring broad and generic statements wherever possible.

ISO 9001-2015 attempts to set out the basic procedures that an organization needs to take to implement a quality management systems. It sets out a number of basic requirements, such as having a quality policy, distributing organizational responsibilities appropriately, maintaining competence and awareness in the staff, and others. The execution of each of these steps is left entirely to the organization, as the standard aims to be suitable for every industry and therefore cannot provide any specifics. With that said, the ISO provides certification services, in which certified auditors can assess the organization for compliance with the standards (International Organisation for Standardisation, no date). As the adoption of quality management systems grew, these certifications have become increasingly demanded, and thousands of organizations have received them worldwide to date. The standard is now well-known and popular, and it is advisable for any organization to familiarise itself with it and comply with the requirements.

ISO 14001 aims to fulfil the same purpose for environmental management systems that ISO 9001 occupies for quality management frameworks. It sets out many similar requirements in another large checklist that the organization should fill out based on its context and experience. To further reinforce the similarities, the ISO also provides certification to the standard, though it is not yet as widespread as that for ISO 9001 (International Organisation for Standardisation, 2015). With that said, certifying to it may be seen as a way of showing the organization’s stakeholders that it is committed to becoming and remaining environmentally friendly. Both ISO 14001 and ISO 9001 have been revised in 2015 to match the latest developments in their respective fields. They demand continuous improvement from their users and are themselves regularly maintained to remain relevant.


Green supply chain management is an emerging topic of substantial importance for various organisations. However, it is currently mostly being considered in the context of its utility to various manufacturing companies, where it is relatively simple to discern the patterns of pollution generated throughout the supply chain. On the other hand, in healthcare, the topic remains inadequately explored, and managers are often unaware of it or see little reason to adopt it given their work environment. However, in cases where it has been applied, the potential for substantial improvement has been discovered. Moreover, the ISO 9001 and ISO 14001 frameworks appear to be suitable for application in the healthcare industry through different approaches, notably those of Australia and Turkey. As such, a comparison between the two to determine the viability of green SCM and the approach that generates the most success is warranted for the further development of the relevant theory.

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